The Disease:

Degenerative Myelopathy (DM) was first described as a specific degenerative
neurologic disease in 1973. Since then, much has been done to understand the
processes involved in the disease and into the treatment of DM. Hopefully,
this will help you understand the problem and to explain further the steps
that can be taken to help dogs afflicted with DM.

The age at onset is 5 to 14 years, which corresponds to the third to sixth
decades of human life. Although a few cases have been reported in other large
breeds of dogs, the disease appears with relative frequency only in the German
Shepherd breed, suggesting that there is a genetic predisposition for German
Shepherd dogs (GSD) in developing DM. The work presented here and by others
on the nature of DM has been performed in the German Shepherd breed. Care
must be taken in extrapolating this information to other breeds of dogs.
It is currently not known whether the exact condition exists in other breeds
of dogs. Many dogs may experience a spinal cord disease (myelopathy) which
is chronic and progressive (degenerative); but, unless they are caused by
the same immune-related disease which characterizes DM of GSD, the treatments
described herein may be ineffectual. The breeds for which there is data to
suggest that they also suffer from DM of GSD are the Belgium Shepherd, Old
English Sheep Dog, Rhodesian Ridgeback, Weimaraner and, probably, Great Pyrenees.
Confirmation of the diagnosis is important in other breeds before assuming
that they have DM of GSD.

Diagnosis of DM is made by a history of progressive spinal ataxia and weakness
that may have a waxing and waning course or be steadily progressive. This
is supported by the neurologic findings of a diffuse thoracolumbar spinal
cord dysfunction. Clinical pathologic examinations are generally normal except
for an elevated cerebral spinal fluid (CSF) protein in the lumbar cistern.
Electromyographic (EMG) examination reveals no lower motor unit disease,
supporting the localization of the disease process in the white matter pathways
of the spinal cord. Spinal cord evoked potentials recorded during the EMG
do show changes which help determine the presence of spinal cord disease.
Radiographs of the spinal column including myelography are normal (other
than old age changes) in uncomplicated DM. Unfortunately, myelography can
be associated with worsening of clinical signs and carries some degree of
risk for certain patients.

Dogs afflicted with DM have depressed lymphocyte blastogenesis to plant
mitogens. The depression of their cell mediated immune responses correlates
with the clinical stage and severity of the disease. Furthermore, this suppression
has been shown to be due to the genesis of a circulating suppressor cell.
Some dogs with DM exhibit antigen-binding cells specific to canine myelin
basic protein. Immunoglobulins have been shown to be bound within lesions
within the spinal cords of dogs with DM. These patients also show increased
circulating immune-complexes in their sera. The antigens in these immune-complexes
have been examined and appear to be markers of inflammation as they have
been found to exist in patients who have other inflammatory diseases of the
central nervous system. 2-Dimensional electrophoresis of CSF proteins indicates
that the elevated proteins in the CSF of DM patients represent changes which
are related to inflammation. While these changes are not specific for DM,
the other conditions in which the inflammatory proteins have been found in
CSF can be differentiated by clinical signs. The 2-dimensional electrophoresis
of CSF proteins appears to be one of the most specific change seen in DM.
Recently, we have found that CSF levels of the enzyme, acetylcholinesterase,
are elevated in patients with DM. Again, this occurs in other forms of central
nervous system inflammation in dogs. However, when combined with the history,
neurologic signs, CSF protein concentration and EMG, the elevated CSF acetylcholinesterase
level helps confirm the diagnosis. This allows the inclusion of DM in the
diagnosis, even if other problems are uncovered during the examination.

The gross pathologic examination of dogs with DM generally is not contributory
toward the diagnosis. The striking features being the reduction of rear limb
and caudal axial musculature. The microscopic neural tissue lesions consist
of widespread demyelination of the spinal cord, with the greatest concentration
of lesions in the thoracolumbar spinal cord region. In severely involved
areas, there is also a reduced number of axons, an increased number of astroglial
cells and an increased density of small vascular elements. In the thoracic
spinal cord, nearly all funiculi are vacuolated. Similar lesions are occasionally
seen scattered throughout the white matter of the brains from some dogs,
as well. Many patients have evidence of plasma cell infiltrates in the kidneys
on throughout the gastrointestinal tract, providing a hint to the underlying
immune disorder causing DM.

During the past two decades, we have provided
important new insights into the pathoetiology of DM. The release of antigens
during the disease process could explain the immune deficits seen in DM and
suggests that processing these immune-complexes by circulating macrophages
leads to the development of the circulating suppressor cells that were previously
noted. This provides a logical explanation for the presence of immune abnormalities
in GSD with DM. Electrophoresis of immune-complexes demonstrates that the
proteins present are inflammatory proteins which increase in inflammatory
diseases of the dog nervous system. It is hoped that working with the antigens
present in the immune-complexes will lead to a major breakthrough in our
understanding of DM and that this also could lead to an early serodiagnostic
test for the condition. However, the development of a serodiagnostic test
will await the availability of antibodies specific to unique markers within
the inflammatory proteins of DM dog immune-complexes.

While the cause of the altered immune system is not known, what is increasingly
clear is that DM is caused by an autoimmune disease attacking the nervous
systems of patients, leading to progressive neural tissue damage. In many
respects, DM is similar to what has been discovered about the pathogenesis
of Multiple Sclerosis in human beings. In fact, based upon new data concerning
the pathology of MS, we can now say with some degree of certainty that DM
is MS in dogs. We believe that, due to some triggering factor, immune-complexes
circulate. These immune-complexes lead to endothelial cell damage in the vessels
of the CNS. Subsequently, fibrin is deposited in the perivascular spaces.
When this degrades (point of action of aminocaproic acid), inflammatory cells
are stimulated to migrate into the lesions. The inflammatory cells release
prostaglandins and cytokines (point of action of vitamin E and C) which leads
to the activation of tissue enzymes and the formation of oxygen free-radicals
(point of action of acetylcysteine) which, in turn, leads to tissue damage.
Treatment of DM of GSD, which we recommend, is directed at these pathologic
processes.

The Integrative Medical Approach to Treatment of Degenerative Myelopathy:

The treatment of DM involves four basic approaches:

1) exercise

2) dietary supplementation

3) medication

4) other supportive measures

Rationale:

Degenerative Myelopathy is an autoimmune disease whereby the patient's own
immune system attacks their central nervous system. This immune attack leads
to loss of myelin (insulation around nerve fibers) and axons (nerve fibers).
While it begins and is most severe within the thoracolumbar (middle back)
spinal cord, DM also affects other areas of the central nervous system including
the brain stem and sub-cortical white matter. The cause of this autoimmune
disease is not known, but there are probably genetic, environmental and toxic
factors which eventually lead to its development. Conventional medicine has
little to offer patients with DM. On the other hand, use of exercise, certain
vitamins and selected drugs have delayed or prevented progression of DM in
many afflicted dogs. While these treatment modalities have been directed
at suppression of the clinical signs, little has been done to prevent the
development of this autoimmune disease.

The purpose of this paper is to provide a rationale for treatment of German
Shepherd dogs afflicted with DM with dietary alternatives and certain dietary
supplements, hoping to prevent or correct the immune dysfunction which leads
to the development of DM. Most of the suggestions presented here have been
extrapolated from the human disease most similar to DM in dogs, Multiple
Sclerosis, or its animal model, experimental allergic encephalitis. Additional
information about the integrative treatment of MS can be found on Dr. Weil's
web page (http://www.drweil.com). Dr.
Weil teaches integrative medicine at the University of Arizona's Medical School.

Exercise:

The importance of regular aerobic exercise in the prevention of chronic degenerative
diseases should not be overlooked. Many studies in human beings have demonstrated
improved muscle performance, memory and cerebral blood flow in patients who
undertake aerobic exercise. Many of the goals of treatment in DM are obtainable
through regular exercise. Two forms of exercise seem the most useful: walking
and swimming. Both have their merits and they may not be exclusive. A number
of owners have reported that swimming assists dogs beyond the exercise of
mere walking. Swimming generally increases muscle tone and allows movement
without stress on joints. Walking, on the other hand, helps build strength,
since gravity is involved. In older patients, particularly those with arthritis,
gradually building the exercise program is important. In addition, allowing
a day of rest between heavy workouts can help the patient recover faster
from the exercise. A good general reference of exercise physiology and exercise
programs is a book by Jeff Galloway: Galloway's Book on Running, Shelter
Publications, Inc., Bolinas, CA, 1984.

Exercise is extremely important in maintaining the well being of affected
dogs, maximizing muscle tone and maintaining good circulation and conditioning.
This is best achieved by an increasing schedule of alternative day exercise.
Running loose on the owner's property is not adequate; regular periods of
programmed continuous exercise are the most important. It is equally important
that the patient with DM be allowed to rest on the day when exercise is not
programmed. This will allow strained muscles and tendons to heal and increase
the build up of muscle strength. The dogs do not have to be confined, only
that they are not encouraged to do strenuous exercise on the "off" day. I
recommend starting with 5-10 minutes of walking or swimming every other day
for 2 weeks. Then, increase the length of exercise time to a goal of 30 minutes
twice a week and a long walk of 1 hour once a week. If your dog already exceeds
this limits, that is fine. However, remember to provide a day of easier exercise
between vigorous workouts. This is particularly important as the patient
gets older. If the patient exhibits muscle or joint stiffness on the day
following vigorous exercise, try ginger, garlic, mustard and feverfew to
reduce inflammation. Alternately, carprofen (Rimadyl 2 mg/kg twice a day)
or acetaminophen (5 mg/kg up to 3 times a day) may help make the patient
more comfortable. Many DM patients have remained functional because of exercise
alone. We use to think that hospitalization was harmful to patients. We now
know it is the lack of exercise which is harmful. Make sure your pet gets
their exercise if they are hospitalized or kenneled for any period of time.

Supplementation:

Dietary Considerations:

Dietary and dietary supplement management of DM has not received great
attention. We, and others, have long sense recommended certain dietary additives
do in part to deficient levels of certain vitamins in dogs afflicted with
DM, yet dietary supplementation has not resulted in more than mild reduction
in the rate of progression of the clinical signs. On the other hand, diet
may have a powerful influence on the development of chronic degenerative
diseases and new information suggests that dietary regulation might play
a more significant role in the progression and development of diseases like
MS. Elimination of toxins from pre-processed food may assist in preventing
a number of immune-related disorders. The current treatment of DM is designed
to suppress the immune disease, but does nothing to correct the immune alterations
which led to the disease state. Diet might help in correcting this defect
and allow the immune system in DM dogs to stabilize. The principles of dietary
therapy are outlined here, including a "home-made" diet. For those who cannot
"cook" for their dog, the basic diet should be supplemented with the additional
ingredients list below. It is best to choose a dog food which is close in
protein content and is as "natural" as possible. Wild dogs were not meat
eaters. They ate bodies, including intestinal contents (often laden with
plants and plant materials). Dogs have evolved so that eating animal fats
and protein do not cause them to suffer the same problems as human beings
when eating these sources of saturated fats. Even so, dogs probably suffer
from the same causes of dietary and environmental intoxication which affects
human beings.

The basic diet and its components have been checked for balance. In addition
to the basic components, we are adding vitamins, minerals and natural herb
supplements for which no specific requirement is known or at levels which
are to provide a specific pharmacologic effect. Again, we recommend those
compounds which scientific evidence supports their efficacy. Used according
to the following formula, the diet and compounds should not do any harm and
have the potential to do good. By cooking for your dog, you can select healthy
products which do not have preservatives and additives which might be harmful.
In addition, you have the option to use organically grown foods. If the dietary
approach is successful, DM patients may not need to use other medications
to prevent further deterioration. It is also possible that this diet might
prevent the development of DM in dogs who are presently healthy. These hypotheses
will be evident in the future, if they remain true.

This diet (1 serving for 30-50 pounds body weight) provides approximately
1160-1460 calories per serving. You can substitute poultry meats, beef and
lamb for the pork chop. This will alter the composition slightly, mainly by
added additional fat. The weight of meat is based upon boneless weight. Most
of the items can be prepared in a microwave. Based upon your dogs body weight,
you will need to make more or less. For example, if your dog weighs 80 pounds,
multiply all the ingredients by 1.5 (can be as high as 2.5 times, though),
keeping their relative proportions. This is a starting point. You can also
make this portion of the diet in advance, aliquot it into appropriate quantities
and freeze it for later use. Just before feeding time, remove the diet from
the freezer and thaw in hot (or boiling) water or microwave to defrost. To
complete the diet, add (amount per serving) before serving:

1 tsp Dry Ground Ginger

2 Raw Garlic Cloves (crushed)

½ tsp Dry Mustard

1 tsp Bone Meal

Using the above diet, approximately 1 serving equals 1 can of commercial
dog food. The exact requirements for your dog can be approximated by substituting
the diet on that basis. You should weigh your dog each week, if losing weight,
increase the amount of the diet given. If gaining weight, cut back on the
amount given. Eventually, the correct amount will be clear. The reason why
the amount has such a broad range in that ideas about the daily caloric requirements
vary. Since many German Shepherds have sensitive stomachs, it may be wise
to phase in the new diet by mixing it with their existing food until they
have adapted. Start by mixing the diet with their existing food in equal
amounts. After 1 week increase the diet to 75% of their food. After another
week, switch completely over to the diet. This diet is balanced and high
in most of the vitamins and minerals which your dog will need. Any shortcomings
will be corrected with the supplements given below as part of the treatment.

Note: The general purpose of the diet is to provide excellent
quality of ingredients with protein coming from Soybean curd (tofu). Tofu
contains many valuable flavonoids and other ingredients which promote health.
If you decide to use a commercial food, you may want to use a Soybean Concentrate
which contains these ingredients, but lacks the extra protein. Alternatively,
you can add tofu to the diet (5-6 oz/day) and add honey or molasses to it
(¼ cup) to make it taste better. Reduce the commercial diet by 25-33%
and monitor your dogs weight, reducing or increasing the commercial diet
accordingly. The addition of raw garlic is to provide garlic's anti-inflammatory
action and (since it is raw) to provide an antibiotic action. Raw garlic is
anti-bacterial and anti-fungal. This action is lost when garlic is cooked
or dried. Dry ginger is also a good anti-inflammatory. Together with garlic,
dry ginger can replace the need for aspirin-like (NSAID) drugs. Fresh ginger
or pickled ginger are also good anti-emetic compounds, calming the stomach.
Mustard provides ingredients which support improved digestion and bowel function.
So, raw garlic, dry ginger (occasionally using fresh or pickled ginger) and
dry mustard should be added to the food, even if it is commercial. These
will not unbalance the commercial food, providing important drug properties
without the side-effects of "non-natural" drugs. Using the vegetables, the
diet also provides many nutrient and vitamins which are not found in commercial
dog food. If commercial dog food is given, giving extra Soy Concentrate,
Soy Lecithin and Beta-Carotene to the diet will improve the commercial food.
They are not needed, if you feed the above diet. The diet provides a balanced,
moderate protein and fat diet which is high in many essential nutrients.
The only commercial food which fulfills many of the goals is Nature's
Recipe Canine Vegetarian Diet, available from many specialty pet
supply stores.

Supplements (dietary):

Vitamins:

B-Complex:

B vitamins are water soluble and any excess amount will be eliminated
through the urine. They may help in neural regeneration and are something
which should be given to dogs. No dog should die while having cheap urine.
In DM, there is altered absorption of some B vitamins and supplementation
can correct this. If your dog is healthy, then give high potency B-complex
(containing approximately 50 mg of most of the B components). If your dog
has DM, give stress formula B-complex containing 100 mg of most of the B
components.

Yeast:

Nutritional yeast, in powder or flake form, is a good source of the
B-complex vitamins, trace minerals, and some protein. It is not expensive.
A heaping tablespoon of yeast will color your dog's urine yellow (owing to
its content of riboflavin). You may sprinkle it on the diet, as an alternative
to giving your dog a B-complex pill. However, it may be more difficult to
be sure you are giving the right dose. Try 1-2 T with eat meal.

Antioxidants:

Vitamin E:

Vitamin E is an important nutrient which has been shown to have a
number of physiologic and pharmacologic effects. It is a potent antioxidant
and reduces fat oxidation and increases the production of HDL cholesterol.
At higher doses it also reduces cyclooxygenase and lipooxygenases activities,
decreasing production of prostaglandins and leukotreines. As such, it is a
potent anti-inflammatory drug. It will reduce platelet function and prolong
the bleeding time slightly in healthy individuals. There is no known side-effects
to vitamin E at levels less than 4000-6000 IU per day (except in cats, where
levels >400 IU/day might create hepatolipidosis). This drug slows the
progression of DM and corrects for low serum and tissue levels. In DM, there
does appear to be a deficient absorption and tissue-binding protein which
accounts for the low serum and tissue concentrations of vitamin E. I recommend
that vitamin E be given to all German Shepherd dogs. For GSD under 2 years
of age, give 400 IU of vitamin E daily. For GSD over 2 years of age, give
800 IU of vitamin E daily. If your dog develops DM, then the dose of vitamin
E should be increased to 2000 IU daily.

Vitamin C:

Vitamin C works with vitamin E and helps regenerate vitamin E, potentiating
its antioxidant effect. Vitamin C supplementation does no harm, since the
excess is excreted through the kidney. While dogs produce vitamin C in their
bodies (unlike human beings, pigs and guinea pigs who must have it in their
diet), under stress or disease, they may need vitamin C in excess of their
manufacturing capacity. In excessive dose, vitamin C can cause flatulence
and diarrhea. This intestinal tolerance level varies among dogs, but is generally
around 3000 mg per day in an adult GSD. I recommend this be given to all
GSD. For GSD under 2 years of age, give 250 mg vitamin C twice a day. For
GSD over 2 years of age, give 500 mg of vitamin C twice a day. If your dog
develops DM, then increase the vitamin C to 1000 mg twice a day unless this
level causes diarrhea.

Selenium:

Selenium is an important mineral which has antioxidant properties
similar to vitamin E. Vitamin E can replace the requirement for selenium
in the body, but selenium cannot substitute for vitamin E. In addition, selenium
does not cross the blood-brain barrier like vitamin E. On the other hand,
selenium may help allow vitamin E to be more effective. Many plant sources
are low in selenium and supplementation may be important. Selenium can create
toxicity if given at too high a level; therefore, never give more that 200
µg of selenium per day in large dogs nor more than 100 µg per
day to small dogs. Below these levels, selenium should be safe. I recommend
giving selenium to GSD. For GSD under 2 years of age, give 100 µg of
selenium daily. For GSD over 2 years of age, give 200 µg of selenium
daily.

Membrane stabilizers:

Omega-3 fatty acids:

Omega-3 fatty acids like EPA (eicosapentaenoic acid) and DHA (docosahexaenoic
acid) are the constituents of fish oils that act as anti-inflammatory agents
and may be worth trying if your dog has an autoimmune disorder or arthritis.
Many versions of these substances are on the shelves of health-food stores,
from salmon oil to capsules of concentrated EPA. However, eating some cooked
salmon or sardines may have benefits over capsular forms of the fish oils.
Alternatively, you can give ground flax seeds, flax oil, or hemp oil as a
dietary supplement; rather than fish oils. These materials will reduce platelet
function for a brief period in dogs, but it seems that dogs compensate for
this within about 8 weeks. Omega-3 fatty acids replace the 2-series fatty
acids over time. As such, cellular stimulation produces 3-series prostaglandins
and thromboxanes. The latter does not cause inflammation and reduce blood
flow like the 2-series thromboxanes. I recommend all dogs receive a 1000
mg of fish oil capsule, 1 T ground flax seeds or eat 2 sardines every day.

Gammalinolenic acid:

Borage oil, evening primrose oil or black currant oil, are natural
sources of gammalinolenic acid, a fatty acid which is hard to get in the
diet. GLA is an effective anti-inflammatory agent with none of the side effects
of anti-inflammatory drugs. It also promotes healthy growth of skin, hair,
and nails. It may be good for skin conditions, arthritis, and autoimmune disorders.
It takes six to eight weeks to see changes after adding GLA to the diet.
I recommend all dogs receive 500 mg of GLA twice a day, either as borage
oil, evening primrose oil or as black currant oil.

Soybean Lecithin:

Lecithin is a fat-like substance found in the cells of the body. It
may combat atherosclerosis, improve memory, and fight Alzheimer's disease
in human beings. However, there is no scientific evidence to support these
claims. On the other hand, lecithin is harmless. It is not necessary as a
supplement unless your dog has DM and you elect not to use the diet proposed
above. (There is plenty of soybean lecithin in the tofu.) If you decide to
use commercial dog food, add 1-2 tsp of soybean lecithin granules to the
food at each feeding.

Coenzyme Q:

Coenzyme Q also called Co-Q-10, is a natural substance that assists
in oxidative metabolism. It may improve the utilization of oxygen at the cellular
level, and patients with heart, muscle and nerve problems may find it worth
trying in doses of 30-100 milligrams a day. Some human beings report that
it increases their aerobic endurance. Coenzyme Q is harmless, but not cheap.
It is probably not worth supplementing your dog with Coenzyme Q, if it is
healthy. However, since DM patients suffer from nervous system problems,
muscle wasting and need aerobic endurance, I recommend giving DM patients
100 mg Coenzyme Q daily.

Tonic herbs (natural remedies):

Ginkgo leaves:

One tonic I recommend is an herbal preparation made from the leaves
of the ginkgo tree (Ginkgo bilboa). Recently extracts of ginkgo leaves have
attracted much attention from researchers because of their ability to increase
blood flow to the brain. You can buy capsules of these extracts in most health-food
stores, although different brands vary considerably in their content of active
ingredients (ginkgocides). Ginkgo is nontoxic. For DM dogs, give 1 capsule
twice a day.

Ginseng: (males only)

Two species of ginseng are available: Oriental ginseng (Panax ginseng)
and American ginseng (Panax quinquefolium). Both are full of compounds (ginsenosides)
that work on the pituitary-adrenal axis, increasing resistance to stress
and affecting metabolism, skin and muscle tone, and hormonal balance. Oriental
ginseng is more of a stimulant and can raise blood pressure in some people,
so I recommend using only the American species for dogs. Ginseng probably
has little to offer young dogs, but may provide an increase in vitality to
an older one. I recommend using 1 capsule of American ginseng once or twice
a day in male dogs over 6 years of age. (Obviously, this includes male GSD
who have DM!)

Dong quai: (females only)

Dong quai is a Chinese herbal remedy made from the root of Angelica
sinensis, a large plant in the carrot family. It is often called "female ginseng,"
because it is a general tonic for women and the female reproductive system
in much the same way that ginseng acts as a tonic for men and the male reproductive
system. Dong quai is available in the form of encapsulated extracts. It is
a good general remedy for female dogs who lack energy. I recommend using
1 capsule of dong quai once or twice a day for female dogs over 5 years of
the age.

Green tea:

Green tea is a good general tonic and has some cholesterol lowering
effects. It also contains theophylline which can help boost energy. It is
available as a capsular extract or you can make green tea and add it to the
diet. I recommend 1 capsule (or cup) twice a day for DM dogs.

Grape seed extract:

A great deal of recent evidence supports the value of grape seed extract
in reducing free radicals and decreasing the chances of developing chronic
diseases. It is best to use standardized extracts. Alternatively, your dog
can drink 1 cup of "purple" grape juice. The dose of the extract is 1 capsule
(50 mg) daily for DM dogs.

Hydergine:

One prescription drug hydergine, derived from ergot (a natural fungus)
may be worth trying, since it appears to help regeneration of nerve cells
and fibers. It is nontoxic; however, some dogs experience GI upset and diarrhea
when starting hydergine. It is probably best to start it at 2.5 mg three
times a day for 2 weeks. If no problems are seen, then increase to the dose
of 5 mg every 8 hours. Unfortunately, it is expensive, since you will have
to give high doses for months or years; cheaper generic forms are available
from Westlab Pharmacy (1-800-4WESTLA).
For dogs with advanced DM, give 5 mg three times a day for at least three
months. I only recommend this for dogs with advanced DM, since it can cause
GI upset, holding it in reserve until truly needed. Your veterinarian will
have to prescribe it for you.

Siberian Ginseng:

Siberian ginseng is derived from the root of a large, spiny shrub
(Eleutherococcus senticosus) found in Siberia and northern China. It is a
relative of true ginseng, but has entirely different properties. Siberian
ginseng has "adaptogenic" properties and reduces physiologic responses to
stress. Scientific investigations suggest it increases physical performance
and endurance and improves immune function. For dogs with DM, given 1 capsule
twice a day.

Bromelain/Curcumin:

Bromelain is an extract of pineapple stems which has the property
of decreasing circulating immune-complexes. As such, there is no Western
medicine which is its equal. Since many of the complications and the direct
initiation of the immune damage may be caused by the elevated immune-complexes
in DM, bromelain may be an important key in helping to control the progression
of DM. Curcumin (the yellow pigment of turmeric plants) is a potent anti-inflammatory
agent. Bromelain and curcumin have a synergistic effect whereby they assist
the absorption of each other from the gastrointestinal tract, increasing their
potency. As such, they should be given together. Many health food stores
carry combinations of bromelain and curcumin. For dogs with DM, give 400-500
mg of bromelain with 500-400 mg of curcumin twice a day. (Curcumin is found
in low concentrations in the spices turmeric and yellow mustard. As such,
it is possible to replace the "capsule" form by adding 1-2 Tbs of turmeric
and 1-2 tsp of dry yellow mustard to the diet.)

Feverfew:

Feverfew is a natural NSAID compound without the side-effects of prescription
drugs. It can be used in dogs with pain or arthritis to help reduce inflammation
and discomfort. I do not recommend it for routine use; but, if your dog has
pain from arthritis, give 1 capsule every 8-12 hours as needed. You can use
this for 5 days out of the week, safely.

Note: WestLab
Pharmacy has developed a palatable vitamin/mineral/herb product (Antiox-Q)
which contains bovine cartilage, coenzyme Q, vitamin E, GLA, omega fatty acids,
selenium, ginkgo, bromelain, curcumin, olive oil and B complex. This product
contains the correct dosage of these compounds and only needs the addition
of vitamin C, the ginsengs, green tea and grape seed to be complete. They
may be contacted at 1-(800)-4WESTLA [1-(352)-373-8111, locally].

Medication:

Over the last 2 decades, we have found 2 medications which appear to prevent
progression or result in clinical remission of DM in many (up to 80%) of the
patients. These medications are aminocaproic acid (EACA) and n-acetylcysteine
(NAC). We recommend giving EACA as a solution, using the generic product.
This product, while designed for injection, can be mixed with chicken broth
to provide a palatable solution for oral usage. We mix 2 parts of aminocaproic
acid solution (250 mg/ml) with 1 part chicken broth and give 3 ml of this
mixture orally every 8 hours. In our experience, this mixture has been equally,
if not more, effective to the tablet form of EACA. Besides, the solution
is much less expensive than the tablets. The generic form of EACA solution
can be obtained from American Regent, 1-(800) 645-1706 (outside of NY). The
generic drug from American Regent may be obtained through prescription with
the help from a local pharmacy. An alternative source for EACA is to have
a compounding pharmacy make the solution from chemical grade EACA. One such
pharmacy is WestLab Pharmacy
in Gainesville, FL. They can be reached at 1-(800) 4WESTLA [1-(352) 373-8111,
locally] and can mail the medication and bill the client directly. The only
side effects that have been attributed to EACA have been occasional gastrointestinal
irritation. This presents a problem only in a few patients, usually who have
pre-existing GI problems that the medication might exaggerate. A local pharmacist
can help in determining whether any additional drugs might be contra-indicated
or lead to possible drug-interactions with the recommended therapy. The only
known interaction is with estrogen compounds; but, only in high doses.

Acetylcysteine is a potent anti-oxidant which has powerful neuroprotective
effects. We give 75 mg/kg divided in 3 doses a day for 2 weeks. Then, we give
the 3 doses every other day. The N-acetylcysteine comes as a 20% solution
and must be diluted with chicken broth (or other compatible substitute) to
5%. Otherwise, it will cause stomach upset. This new treatment is expensive
unless purchased through compounding pharmacies. Again, WestLab Pharmacy has this product
and can send it to clients upon veterinary prescription. Using N-acetylcysteine
at the above dosing does not appear to have side-effects. It can produce
vomiting and may increase the bleeding time. The GI upset is likely due to
the sodium content of the pharmaceutical product, which requires high concentration
of base to buffer to pH 7.4. By reducing the pH during preparation, WestLab's
product does not have as many side-effects. Giving fresh ginger 30 minutes
before and giving the NAC with food (or on a full stomach) often reduces
this effect.

The combination of aminocaproic acid, N-acetylcysteine, dietary supplements
and exercise is the best treatment we have been able to discover to date.
It corrects those aspects of the immune dysfunction which we can treat, based
upon our belief that DM is an immune-mediated inflammatory disease. We always
hope that all patients will respond to our treatment protocol. Unfortunately,
it does not work in all cases; however, this combined treatment has been
up to 80% effective in patients diagnosed at the University of Florida. The
chances of successful treatment are improved if the therapy is begun early
in the course of DM rather than later. A response to the drugs should be
evident within the first 7-10 days. There is no other medications that we
have found to provide any real benefits in the long term treatment of DM.
Further information about other treatments may be found in Current Therapy
X, pages 830-833 and in Vet. Clin. Nor. Am. 22:965-971, 1992.

Other Supportive Measures:

Heartworm medication:

Since the monthly heartworm medications (Heartgard, Heartgard plus and
Interceptor) increase immune responsiveness, we do not recommend using these
products. Instead, we recommend plain diethylcarbamazine (DEC or Filaribits)
which must be given daily. I do not recommend Filaribits plus (some dogs
experience liver problems using it). If your dog is currently taking a monthly
heartworm preventative, you must give one last dose and start the daily medication
the next day. This is because the medications work at different points in
the heartworm "life-cycle". Revolution, which is a new topical heartworm
preventative, does not alter the immune response like the other monthly products.
As such, Revolution should be safe to use in DM to control internal (and
external) parasites.

Flea prevention:

Many of the old and new flea product can cause problems when certain neurologic
conditions are present. As such, we recommend using boron, pyrethrums and
Precor as the main control methods. Of the new medications, Frontline Spray
and Revolution may be safe to use.

Acupuncture:

The traditional Chinese art of insertion of needles into various specific
points of the body (with injection of small amounts of fluid or electrical
stimulation) has been shown to provide analgesia and relief from acute and
chronic pain. This has the advantage of having none of the side-effects of
analgesic drugs. In addition, acupuncture can do no harm. In DM, acupuncture
alone slows the condition, but does not stop the progress. One the other hand,
DM patients who have concurrent arthritis may benefit from acupuncture therapy.

Dietary Cartilage:

In many cases of degenerative joint disease with arthritis, recent studies
have suggested that glycosaminoglycans and chondroitin sulfate may help reduce
pain and inflammation from osteoarthritis, assisting in the healing process.
While these products are available through health-food stores or a pharmaceutical
medication through your veterinarian, you can give these to your dog directly
by giving cooked cartilage. Sources of dietary cartilage would included cooked
and "de-bone" chicken wings or using cooked spare ribs as the meat source
in the diet. Why pay for cartilage products if it can be gotten for free
in the dietary source. Some people taught the benefits of shark cartilage,
but there are no scientific studies to support these claims. (It is also
ecologically unsound to kill sharks to harvest their cartilage.) On the other
hand, increase dietary cartilage can do no harm, particularly in the face
of arthritis. In DM patients with arthritis, I recommend 1-2 grams of dietary
cartilage with each meal. Another alternative is bovine gelatin (Knox gelatin
or Knox Nutrajoint) which can be added to the food (1-2 packages per feeding).
In some dogs, using glucosamine/chondroitin sulfate complex will be beneficial
in controlling joint pain and stimulating healing; however, dietary cartilage
has these compounds along with other important ingredients. Forms of glucosamine/chondroitin
sulfate complex are available at health food store. (These are cheaper than
products available from your veterinarian and may work as well) I recommend
around 1200 mg of glucosamine and 1500 mg of chondroitin sulfate daily, if
other forms of cartilage are not available.

Stress Reduction:

DM progresses at different rates and "stress" plays a role in its advancement.
Minimizing stressful situations is important where possible. While anesthesia
does not appear to cause problems with DM; in the past, even minor invasive
surgical procedures can result in a marked increase in clinical signs of DM.
Unfortunately, the worsening caused by surgical stress can be irreversible.
Due to the advent of N-acetylcysteine therapy and being more attentive to
the continued exercise of hospitalized DM patients, we now have been successful
in performing many surgical procedures in these dogs. These have included
cervical and thoracolumbar disc surgery and total hip replacement. Before
aggressive surgeries are considered, it is best to determine that the patient's
neurologic status is stable. Post-operative physical therapy remains crucial
in getting patients on their feet quickly.

Note: If your dog already has DM, you should consider treatment
with the above natural products and more traditional aminocaproic acid and
acetylcysteine medications. Use the aminocaproic acid and acetylcysteine for
the first 2 months of therapy and then see if they can be withdrawn (without
signs of deterioration). If so, then continue with the natural approach from
that point on.

The Future for DM:

The key to DM in the future is likely to be prevention. While it may be necessary
to wait for the next generation of GSD to see whether the principles laid
down here work, they can do no harm. Science is only beginning to understand
the fragile nature of DNA and how natural healing can be hampered by dietary
and environmental toxins. The body is endowed with a tremendous capacity
to heal, if we do nothing to interfere with this process. We are the keepers
of our pet's health. We must empower ourselves to accept this responsibility.
Conventional medicine falls short in the treatment of DM, leading to the
need to pursue other forms of treatment. For more information about the positive
aspects of spontaneous healing, read the book by Andrew Weil, MD: Spontaneous
Healing, Ballantine Books, New York, 1995.